Why is educating your clients about nutrition such a vital conversation? [Podcast]
Of the many factors affecting the wellbeing of your patients, nutrition is one area which veterinary technicians can have a lasting impact. This track of the symposium will focus on how to conduct nutritional assessments and become a Nutritional Counselor and Advocate for the patient
- Conduct a nutritional history with client information
- Determine the facts behind pet food labels
- Placement and management of feeding tubes
- Nutrition is the cornerstone of good medicine
- Pet food labels are not straightforward for our clients – and for team members
- Feeding tubes should be used more often by vet healthcare teams
- Using open-ended questions in a nutritional history will get to the facts sooner
- Every pet that visits the veterinary hospital should have a nutritional assessment and recommendation – every time they come to the hospital.
Q: Why nutrition?
A: Proper nutrition is a critical component for maintaining the health of pets. Every patient, healthy or ill, that enters the veterinary hospital should have an evaluation of their nutritional status and healthcare team members should make a nutritional recommendation based on this evaluation.
Q: Why is understanding pet food labels important?
A: The pet food label is the primary means by which product information is communicated from the manufacturer/ distributor to pet owners, veterinarians, health care team members, and regulatory officials. Reading and interpreting pet food labels is one method that healthcare team members and pet owners can obtain information about pet foods; however, labels do not necessarily provide information about food quality (e.g., digestibility and biological value).
Q: What is the benefit of the healthcare team approach to nutritional history taking?
A: All members of the health care team should be familiar with taking a nutritional history. Through this mechanism, the team can pinpoint a breakdown in owner compliance (e.g., are more than one person in the household feeding the pet, is the pet getting more calories than is being recommended, etc.) and begin to establish a feeding protocol to insure the pet’s proper calorie consumption.
Q: If the patient is critically ill, nutrition should be a lower priority, right?
A: Nutritional support is an important therapeutic modality and can aid in the management of diseases. In diseased states, the inflammatory response triggers alterations in cytokines and hormone concentrations and shifts metabolism toward a catabolic state. With insufficient food intake, the predominant energy source is derived from accelerated proteolysis, which in itself is an energy-consuming process. Thus, critically ill animals may actually preserve fat deposits in the face of lean muscle tissue loss. The goal of nutritional support in these catabolic patients is to feed the catabolism with exogenous sources of protein and fat thus sparing endogenous protein which is critical to recovery.
Q: How does nutrition help my critical patients?
A: Malnutrition in veterinary patients is thought to increase morbidity and mortality. In the GI tract, transit times increase, absorptive capabilities decrease, villous atrophy and there is an increased risk of bacterial translocation. In the kidneys, excretion of urinary calcium and phosphorus increases, ability to excrete acid decreases, gluconeogenesis increases and glomerular filtration rate decreases. Malnutrition has been documented to decrease humoral immunity and barrier function (skin and mucosal surfaces), inflammatory response, leukocyte motility and bactericidal activity. Patients are at risk for pulmonary complications as a result of decreased response to hypoxia, decreased lung elasticity, and secretion production, altered permeability and decreased tidal volume. Cardiovascular complications include increased incidence of arrhythmias and decreased weight of the heart muscle. Protein malnutrition may also alter the normal or expected metabolism of certain drugs, which may increase or decrease their therapeutic effect even when given at recommended dosages.
Q: Why should we place feeding tubes?
A: The gastrointestinal tract needs to be fed. The gut receives an overwhelming percentage of its nutrition from the chyme passing through it. In the small intestine, enterocytes utilize lumenal glutamine preferentially as their source of metabolic fuel. The colonocytes prefer butyrate, a short chain fatty acid formed by fermentation of lumenal carbohydrates. In the absence of these fuel sources, the gut epithelium slows growth and replication resulting in atrophy, necrosis and increased risk of bacterial translocation across the now abnormal gut barrier. A key to prevention of this potentially serious problem is providing nutrition support to the gut. The rule of nutritional support is “if the gut works use it”.
Q: Can’t I just syringe feed my patient?
A: Force feeding sick, hospitalized animals is the best way to create food aversions. It is an inefficient feeding method resulting in more nutrients on the patient and the healthcare team member rather than in the patient. Typically feeding will not provide a significant percent of needed calories and will lead to a false sense of accomplishment and continued inadequate intake.
Q: Aren’t all pet foods basically the same?
A: Pet owners and healthcare team members today have access to a lot of information regarding pet nutrition via the internet, news sources, blogs, etc. However, with this wealth of information comes sometimes confusing and incorrect nutritional information. Veterinary technicians need to educate themselves on proper companion animal nutrition and sort through the minutiae to educate well intentioned owners on what constitutes proper nutrition for their beloved pet. There is a lot of misinformation regarding pet food; however, during the WVC Technician Symposium 2016 we will discuss pet food regulation and interpretation of pet food labels.
Q: I ask my owners certain questions during the history taking, but they do not always answer truthfully?
A: Most likely because of the way we are asking the questions. We should ask open ended questions as opposed to closed ended questions. Closed ended questions result in a one word answer – we want to hear all about their pet – especially who is feeding, what they are feeding, what treats, etc. If we ask “Do you give Fluffy treats?” – most likely the answer will be no – not because they are not giving treats, but rather because they perceive our question to be ‘judgemental’. They want to portray they are doing ‘right’ by their pet, and will answer the questions with what they ‘think’ we want to hear.
Q: The package provides feeding guidelines – is this good enough to provide to my owners? I do not like math!
A: Veterinary healthcare teams should be comfortable with calculating the amount of food or the appropriate energy intake of the patient. The pet’s daily energy requirement (DER) reflects the pet’s activity level and is a calculation based on the pet’s resting energy requirement (RER). There are a couple of basic formulas that all technicians should memorize or have on laminated note cards in every exam room (along with a calculator)! You do not need to be a mathematician - They are not difficult.
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